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The Role of Effective Communication in Healthcare When Dealing with Patients with Chronic Illnesses: A Case of Sanandhra, a Cancer Patient

Alongside proficient control of symptoms and pain as well as interdisciplinary teamwork, sufficient communication skills along with interpersonal relationships constitute the threesome basis that maintains palliative care. In uncertainty, suffering, and pain situations, associations are re-signified and connection with people, either healthcare experts or relatives, begins to signify the importance of care that maintains hope and faith, supporting difficult moments’ experience (Zaytoun et al., 2017). Owing to the fact that communication happens through nonverbal cues or speech, knowledge and understanding of interpersonal communication strategies that enhance or facilitate interaction as well as transmit care, comfort, and compassion is of great significance. Therefore, this report aims at discussing the role of effective communication by care providers as they offer care services for Sanandhra and her family in a collaborative multidisciplinary approach. The report begins by giving an overview of Sanandhra’s case, then proceeds to discuss how discussions can happen with Sanandhra’s family, Sanandhra herself, and within the multidisciplinary team, highlighting the communication strategies that should be employed and the factors that should considered when communicating. The report then proceeds to discuss communication techniques and strategies that will assist in addressing (end of Life) EOL issues across the lifespan and finally discuss communication techniques and strategies that will help in identifying and meeting where possible the cultural practices and beliefs that are influencing as well as being influenced by the healthcare that is being provided to Sanandhra.

Sanandhra is a 35 years old lady married to Jack. The couple have two children (Billy (12) and Jade (8)). Sanandhra was born in Indian and speaks English as her second language. Despite being raised as a Hindu, Sanandhra does not often follow the Hinduism teachings since she became “westernised” somewhat. She was diagnosed with breast cancer and treated of the same two years ago after undergoing radiotherapy and chemotherapy. Nevertheless, she has lately noticed a consistent cough as well as an increasing breathlessness. After consulting with her general practitioner (GP), it was confirmed that the cancer had returned and had spread to her liver and lungs. After this, she begins revisit and revise some of religious and cultural beliefs since she had received a terminal diagnosis. Instead of her “Sandy” name that she adopted after being “westernized,” she implored all his family members, associates, and friends to call her Sanandhra. Additionally, she has begun wearing traditional Indian clothing. As a result of the illness, her condition continues to deteriorate by the day. She has to consult with her GP and other teams to ensure that she gets the right pieces of advice regarding how she can go about her condition, Additionally,  she needs to know from teams how well she can communicate her condition to her confidants, family (especially her children), and friends. It is for this reason that this paper proceeds to explore how well communications can be employed to ensure that right steps of actions are taken at every single stage.

After the detection of the return of the cancer and its spread into her liver and lungs, Sanandhra is subjected to palliative care. Palliative care is a total or active care given to a patient whose disease no more responds to curative treatments provided to the patient (Bremner, 2015). Palliative care is aimed at improving the quality of life of patients along with their families, via suitable assessment and treatment to relieve their pains and symptoms, and to provide spiritual and psychosocial support (Kirkendall et al., 2017). The care is directed at relieving a patient’s suffering, concentrating upon the sick individual and not the sickness of the individual, revalorizing and recovering the interpersonal associations during the process of the patient’s dying, humility, honesty, compassion, and empathy as crucial components (Bassett et al., 2018). To effectively realize the objective of a palliative care, the multidisciplinary team attending to Sanandhra can communicate using various strategies. First, they can employ communication strategies that convey messages in such a manner that hope is ultimately given both to Sanandhra and her family members. When communicating anything regarding cancer either to Sanandhra or her family members, physicians attending to her should communicate in ways that convey some measure or element of hope to them (Dahlin & Wittenberg, 2015). Battista and LaRagione (2014) reason that health care providers, like Sanandhra’s GP and nurses, are a great source of hope to patients to the extent that they should be motivated to convey messages in such a manner that hope is inspired in their patients and their patients’ relatives (Lilley et al., 2017). However, care has to be taken when communicating various care issues. When dealing with Sanandhra, a cancer victim, it is important that the multidisciplinary team considers the fact that certain patients have high anxiety for true and complete cancer disclosure to minimize their stress and tension (Pantilat et al., 2017). To this cohort of patients, delay in communication regarding their healthcare status leads to loss of hope both in life and in the care providers (Zaytoun et al., 2017). Conversely, another cohort of patients are not comfortable when information regarding their health status are communicated to them directly to the extent that they would be comfortable when such information is communicated to them indirectly through their relatives. Other patients also do not like information regarding their health status to be communicated to their relatives (Cotter & Foxwell, 2014). As such, in communicating to Sanandhra regarding her conditions, how to go about it, and how to share the information with her family members, the multidisciplinary team should ensure that they determine Sanandhra’s and her family members’ tolerance levels to information regarding Sanandhra’s health. Largely, clinical communication is a multifaceted concept that entails the core of efficient and effective medical practice. Effective communication to a cancer patient, and to all other patients, is the foundation for responsive treatment choices, patient propelled compliance, positive health results, and general high quality of healthcare.

The second strategy that can be employed by the multidisciplinary team to communicate with Sanandhra and her family members regarding Sanandhra’s health condition is through verbal techniques. The multidisciplinary team should ensure that they employ verbal strategies of communication that will allow for free expressions, exchange of expressions,  give better clarification of a Sanandhra’s and family’s condition, and validate conditions. The employment of such verbal communication strategies is informed by the fact that they facilitate description of a patient’s health condition and enable for exploration of challenging facets of the patient’s condition (Bernard et al., 2017). According to Bremner (2015), when dealing with patients undergoing palliative care, there is a need to employ communication strategies that would assist in understanding or clarifying messages received so that necessary correction of ambiguous or inaccurate information can be done. Therefore, the multidisciplinary team dealing with Sanandhra should employ verbal communication strategies that contain expressions that may make the usual meaning of what is communicated or expressed. This would authenticate the correctness of messages received from patients, their family members and form members of the interdisciplinary team itself (Baird, 2015). Nonetheless, the multidisciplinary team should ensure that sufficient time is allotted for verbal communication with Sanandhra and her family members because sufficient time is directly related to the quality of care that would be provided to Sanandhra who is undergoing palliative care (Dahlin & Wittenberg, 2015). Kirkendall et al. (2017) explain that sufficient time in care provision allows for formation of good trust and confidence connections, ensures continuity of interactions, and enhances identification of the multi-dimensional requirements of a patient.

Apart from verbal communication strategies, the multidisciplinary team, Sanandhra, and her family members can employ non-verbal communication strategies (nonverbal signals) as well. According to Pagnamenta et al. (2016), an affectionate touch by a care provider on a patient can significantly influence the communication between the patient and their care providers. Affectionate touch, as Bassett et al. (2018) state, refers to the physical contact that passes information or messages of a passionate or emotional nature. Commonly employed affectionate touch styles are a firm handshake, a hug, a hair caress, a kiss on the cheek, touching arms, hands, and shoulders, as well greeting one with physical contact. Alongside affectionate touch, body language can as well be employed. According to Zaytoun et al. (2017), of the body signals that are commonly employed to communicate, the face (smile and eyes) are the most commonly employed. Other nonverbal strategies that can be used are paraverbal (voice tone) and silence. Owing to proven significance of affectionate touch along with other nonverbal signals on patients, the multidisciplinary team can employ the same on Sanandhra and her family members. A touch on her and her family members would function to arouse their emotions (that could be hidden). Lilley et al. (2017) add that smiling and eye contact are facial expressions or signals that connote interest and, thus, function to facilitate the exchange between a care provider and their patients. Similarly, a look at a patient and their family member has a great significance within a multidisciplinary team: it functions to regulate conversational flow within the multidisciplinary team (Bremner, 2015). Interruption of eye contact between a care provider and patient suggests a lack of interest in carrying on with a conversation, causing the exchange between a patient and care giver impaired or interrupted. For this reason, the multidisciplinary team needs to show important signals for the establishment of a bond and confidence bond when they are dealing with Sanandhra and her family.

Nonetheless, it is important for the multidisciplinary team to remember that a mere physical contact is not configured as a passionate event despite the fact that it functions to stimulate a person’s sensory nerve endings and trigger the individual’s mental and neuronal alterations, which entail one ‘s emotions (Cotter & Foxwell, 2014). Additionally, the multidisciplinary team should take into consideration the culture of their patients and the patients’ family members. According to Dahlin and Wittenberg (2015), certain distances, exchanges, and contacts are regarded unethical. The multidisciplinary team should also note that not all people respond in a similar way to particular nonverbal signals because different cultures and people understand certain signals differently.

Another strategy that can be employed is keeping safe, healthcare, and professional distances with the patient. According to Bassett et al. (2018), physical proximity between a care provider and patient at a personal distance allows for a close a contact minus being invasive or unpleasant as compared to public, social, and intimate distances. This distance enables a patient to hear clearly what is being communicated to them without the care professional changing their voice tone and to comprehend the signals of the professional’s face (Battista & LaRagione, 2014). By approaching Sanandhra and her family at this distance has the potential of conveying a message of interest to Sanandhra and her family, and this is needful for the institution of the bond of empathy and compassion. The last communication strategy and technique that can be employed within the multidisciplinary team when communicating with a patient and her family is active listening. Active listening entails the therapeutic employment of silence, the deliberate emission of nonverbal facial expressions that suggest interest in whatever is being communicated (positive head nods, keeping eye contact), the physical proximity along with the orientation of body alongside the trunk facing toward a patient, in addition to employment of verbal phrases that function to foster continuation of speech, like carry on…, and then…, I hear you …, and okay, among others.

Just like other cancer patients’ conditions, Sanandhra’s equally continued to deteriorate with time. She begins to ask herself several questions, like how will she tell her children about the condition, “I am too young to die”, “how will my children cope without me”, what impacts will her death have on her children, the destruction of life spans both hers and Jack’s along with the effect of her sickness and ultimate death upon her elderly parents who will not have an opportunity to visit with her before her dying, among other questions. Communicating with Sanandhra at this stage is considerably hard. Bernard et al. (2017) state that cancer communication is a very challenging aspect medical practice, and thus requires that clinicians must have proper communication skills particularly when communicating end of life (EOL) messages. The communication is challenging since patients with incurable and advanced cancers deal with several emotional effects of their life-limiting disease, treatment choices that are intricate (radiotherapy and chemotherapy) and frequently engaged consideration regarding clinical tests, and the challenges of maintaining hope while at the same time having realistic objectives (Baird, 2015). For this reason, clinicians need to establish therapeutic association with patients based upon mutual respect and trust with the patients who they usually access a substantial deal of their medical data, come from ethnically diverse extractions, have different social support levels, and who confront the spiritual and existential facets of dying, all in their attempts to access complicated healthcare systems (Kirkendall et al., 2017).

Patients concerns have both emotional and informational components, necessitating that patients be offered emotional and information support aimed at resolving their worries.  They, thus, look to their oncologists for both information and emotional support, and if these concerns are unresolved, affective disorders and physiological distress are often the result (Eggins & Slade, 2015). As such, core communication assists clinicians with skills that help them to elicit concerns and subsequently provide extra compassionate and effective care. One of the strategies and techniques that can be employed in assisting in addressing EOL is eliciting concerns in patients and recognizing cues. For a care provider to address a patient’s emotional and information concerns, there is a need that the concerns are first disclosed and recognized by the care provider. This can be achieved in two ways: the provider can elicit a patient’s concerns, or the patient can spontaneously give cues regarding the patient’s concerns (Pantilat et al., 2017). To elicit their patients’ concerns, the care providers should employ open-ended questions with the aim of allowing more time for the patients to narrate their concerns, and empathy (Tompkins, 2015). Open-ended questions like “How are you doing with all these? or “Is there something more that you would like to tell me today?” allow patients to know that their care providers will be ready and willing to listen. In response, patients will give “cues” to their care providers regarding their concerns, for instance, “I am not sure what other treatment options can help.”

Secondly, the ask-tell-ask technique or strategy can be employed to respond to informational concerns. Patients, just like Sanandhra, need information regarding how their illness and how their illness will affect their families and relatives among other information (Pagnamenta et al., 2016). The make use of this information to schedule their future and to make life and medical decisions (Eggins & Slade, 2015). For this reason, they want their doctors to be realistic and honest in giving them information while remaining sensitive to what information they are really prepared to hear along with how it impacts them (Pantilat et al., 2017). The ask-tell-ask strategy makes sure that the care provider: (1) gives information slowly enough to insure that the patient comprehends and understands (2) remains thoughtful to the impact of the information given on the patient (Bernard et al., 2017; Eggins & Slade, 2015). This is achieved by the care provider bracketing every piece of information given by their patient with questions for purposes of checking understanding along with the effect upon the patient.

Next, empathy is another techniques that can be employed by care providers when responding to their patients’ emotional concerns. The amount of stress associated with cancer along with its treatment are usually associated with great negative emotions: fear, anger, and sadness. Whereas care providers cannot “resolve “the bases of these emotions, studies have shown that offering emotional support enhances anguish. Patients, according to Baird (2015), feel emotionally supported when their care providers shown care for them, by way of spending sufficient time with them, permitting them to interrogate, as well as listening to their anxieties. Physicians can empathically respond to patients’ emotional expressions verbally and non-verbally.

Unfortunately, there are cultural practices and beliefs of patients that can influence and can be influenced by the kind of care provided to patients. Studies have shown that cultural beliefs and practices are important to patients, and therefore should be respected. For this reason, care providers need to be respectful of their patients’ cultural attitudes, beliefs, and practices. To salvage the situation, there are certain communication strategies that can be employed to help in identifying and meeting, whenever possible, the cultural practices and beliefs that are influencing and being influenced by the care being offered to a patient. They include care providers showing consideration of the beliefs and practices of their patients, being polite to their patients, showing honest interest and respect to their patients’ right to confidentiality and privacy (Tompkins, 2015); Pagnamenta et al., 2016). Similarly, care providers need to: keep an open mind regarding every single belief and practice by their patient, be aware about different ways people associate and interact, be informed that gender responsibility may differ from one patient to another depending on their cultures, seek to comprehend the protocols of various ethnicities, and develop an empathy with, as well as an understanding of, their patients who may be suffering cultural challenges with the care being provided (Pantilat et al., 2017). Other communication strategies include being willing and ready to provide information as well as to encourage and seek for input from the patients’ family, community, and individuals, being informed that some patients from certain ethnicities may mistrust the motives of certain care provided, being willing and ready to learn patients’ beliefs and practices and adapt to them if possible, and demonstrating reliability and consistency (Tompkins, 2015).

To this end, it is evident that effective clinical practice involves many occasions where clinical data/information must accurately be communicated. Thus, team collaboration is crucial. When healthcare professionals are not effectively communicating, patient safety may be jeopardized for a number of reasons: lack of crucial data/information, unclear orders via phone, misinterpretation of data, and discounted changes in a status. In essence, lack of effective communication creates situations wherein errors can happen, and the errors have the capability of causing severe injuries or unanticipated deaths. Communications to cancer patients should, however, be tailored in such a way that they give hope to the patients. Unlike patients having other clinical conditions, the communication with a cancer patient, like Sanandhra, is unique owing to the fact that there are certain uncertainties levels associated with survival, treatment, and cure, involvement of a wide range of treatment procedures and modalities, interaction of multiple physicians/clinicians and change in healthcare team from time to time. As mentioned before, a communication strategy that should be employed within the multidisciplinary team when dealing with Sanandhra is the conveyance of messages that function to sustain the patients’ and their families’ hope and faith and supporting the patients’ experience of hard and challenging moments. Similarly, owing to the fact that a means of communication happens in human contact, via nonverbal and speech cues, the multidisciplinary dealing with Sanandhra and her family should have knowledge regarding interpersonal communication strategies and techniques that facilitate the exchange and can convey comfort, compassion, and care to the patient. This is because interpersonal communication within the sphere of palliative care and health is perceived as an intricate process that entails the comprehension, perception, and transmission of messages in the exchange between health care professionals and patients. The process has two dimensions: nonverbal and verbal.